Medical and Like Services: Know your entitlements

Did you know that you are entitled to heaps of Medical and Like services under the workcover Act?

  • Acupuncture:

WorkSafe can pay the reasonable cost of acupuncture services at the request of a medical practitioner if those services are required as a result of a work-related injury or illness.

  • Aids and appliances

Workers are entitled to be compensated for the reasonable costs of personal and household services incurred because of the work place injury.

The definition of a personal or household service includes aids, appliances and apparatus.

To be eligible for reimbursement, these services are to be requested by a registered medical practitioner.

  • Attendant Care

The accident compensation legislation states that workers are eligible for reimbursement for ‘personal and household services’ and the definition of a personal or household service includes attendant care. The legislation also specifies that these services are required to be provided by a person who is approved by WorkSafe.

Attendant care is most often required:

to assist a severely injured worker who is dependent on assistance for aspects of movement, self-care, toileting and activity; to facilitate community access, assistance in social activities and vocational return to work; as part of a hospital discharge plan, which forms the basis of a structured holistic program.

Attendant care is provided to workers to assist with activities of daily living, including: personal care – showering, bathing, dressing, toileting, grooming, eating, drinking, preparation of specially prescribed foods, monitoring of medication, assistance with use of specialised equipment; program implementation – implementation of goal oriented programs, conduct of physical exercise, programs designed to increase skills of daily living; community access and recreation – providing 1:1 support for the attendance at and participation in events and activities;  respite – providing care for a worker to allow the family respite.

You can also request for friends or family members being paid to provide attendant care!!!

Will require medical evidence and support from the treating medical practitioner.

  • Burial/Cremation

WorkSafe can pay the reasonable costs for a burial or cremation incurred within Australia when a worker dies as a result of a work-related injury and there is an accepted WorkSafe claim for the death of the worker.

  • Car modification

WorkSafe can pay the reasonable costs of modifications to a car that are reasonably required as a result of a worker’s injury or illness to enable the worker to drive or to be transported safely (examples:non-functional arm: include a  spinner knob, t indicator extension, modified accessory controls; adjusted mirrors, seat belts, harnesses etc)

Where a worker’s car cannot be modified or the worker does not have access to a car, WorkSafe may contribute a reasonable amount to the purchase cost of a suitable car selected by WorkSafe.

  • Childcare services

WorkSafe can pay the reasonable cost of childcare services at the request of a medical practitioner if those services are required as a direct result of a work-related injury or illness and supported by an independent OT assessment as being necessary and appropriate.

For example, if  you are unable to provide childcare as a result of your injury or illness you can get child care services!

  • Chiropractic

WorkSafe considers chiropractic to be a primary contact service. A referral from a medical practitioner is therefore not required.

  • Community access

WorkSafe recognises that some eligible workers may acquire multiple physical, sensory and cognitive disabilities, which may impact on their ability to access and participate in their social and recreational activities.

Community access services are designed to assist eligible workers to increase their participation in the community by identifying and responding to their individual needs through Community Access Planning and Community Group Programs. These services may be provided to an eligible worker separately or in combination depending on the needs of the worker.

Community access planning is the services provided by a community access planner to an eligible injured worker which aims to: maintain and enhance peer support networks, and facilitate sharing of authorised support services; assess and review the support needed to enable a worker to participate in community bases social or recreational activities; link workers into community bases social or recreational activities; monitor a workers participation in community activities to ensure programs continue to appropriately address the workers needs.

Community group program is an individually tailored program of supported group activities which: is provided within community based facilities; is specifically designed for eligible workers who require support; to engage in social or recreational activities outside the home; supports the development of peer support networks, community living and social skills.

A referral is required from a medical practitioner for the provision of any approved health service with the exception of medical, physiotherapy, osteopathic, chiropractic, optometry, dental and podiatry services.

  • Dental services

WorkSafe can pay the reasonable costs of dental services (including oral and maxillofacial surgery) as a result of a work related injury or illness.

Note: Prior approval is not required for emergency dental treatment requests relating to a work-related injury or illness.

  • Dietetic services

WorkSafe can pay the reasonable cost of dietetic services at the request of a medical practitioner if those services are required as a direct result of a work-related injury or illness.

Note: WorkSafe will not pay for weight loss programs or food/meal replacement services, for example home delivered meal services such as Lite n’ easy or weight loss programs such as Weight Watchers or Jenny Craig.

  • Elective surgery

Elective surgery is clinically necessary, non-emergency surgical treatment (including surgical procedures) performed by a suitably qualified medical practitioner.

Prior written approval from the agent is required for elective surgery. You can have your surgery in a private hospital.

Note: Worksafe will not pay for services provided outside of Australia without prior approval from the agent

  • Equipment and related services

WorkSafe can pay the reasonable costs of equipment and related services to assist a worker in the rehabilitation of a work-related injury or illness, or whose work-related injury or illness has caused impaired function in any of the worker’s activities of daily living.

To consider paying for aids and appliances, WorkSafe requires the following information:

·         A current referral from a medical practitioner for any equipment and related services.  To assess a worker’s eligibility for equipment, WorkSafe also requires a written recommendation from the worker’s treating therapist or relevant healthcare provider

·         For wheelchairs, pressure cushions, beds, mattresses, powered conversion kits, scooters, standing frames, lounge chairs, customised toilet/commode/shower chairs or hoists, an Equipment Prescription Form must be completed by the prescribing therapist and submitted to the Agent.

WorkSafe can pay the reasonable costs of equipment and related services that are reasonable and/or necessary for the worker’s work-related injury or illness.

WorkSafe will take into account whether the equipment and related services will:

·         increase independence

·         facilitate a return to vocational, educational or leisure activities

·         improve mobility

·         relieve pain/discomfort

·         ensure a safe environment

·         aid communication/swallowing management.

Examples: taping – zinc oxide, fixomull, strapping, etc; bandages – compression, tubigrip, thera-band, gauze products; oedema control and dressing bandage;  thermal supports, pressure garments and gloves; soft collars; hand putty/thera-putty digiflex, exercise foam; walking sticks, triangular slings; plaster, ice packs, heat packs; hibitane, iso-wipes, skin-prep, applicators; adaptive cutlery; dressings aids (example, long handled sponge/shoe horn, toe wiper, sock aids, button hooks, elastic shoe laces); pick up sticks.

  • Exercise physiology

In order for WorkSafe to consider payment of the reasonable costs of exercise physiology the medical practitioner referral must be provided to the agent by the worker or healthcare provider.

  • External case management

External case management is a collaborative process with may include an assessment, planning, facilitation and advocacy for options and services to meet an individual’s health needs through communication and the utilisation of available resources to promote quality cost effective outcomes.

WorkSafe recognises that some eligible workers at certain times require assistance beyond the case management role of an agent or the role of treating health care providers. Case management services are a time-limited service that complements the agent’s role.

A referral is required from a medical practitioner for the provision of any approved health service with the exception of medical, physiotherapy, osteopathic, chiropractic, optometry, dental and podiatry services.

  • Gym and swimming programs

WorkSafe can pay the reasonable costs of a gym and/or swimming program at the request of a medical practitioner if those services are required as a result of a work-related injury or illness and to transition to a self-managed exercise program.

Written approval from the agent is required for a gym or swim program.

Example: You have injured your knee – you are allowed to attend gym to strengthen your upper body (arms etc)!!!

  • Hearing services and devices

WorkSafe can pay the reasonable costs of approved hearing services and devices provided by WorkSafe approved hearing service providers to assist workers in the rehabilitation of work-related injuries or illness under s99 of the Accident Compensation Act 1985.

  • Home modification

WorkSafe can pay the reasonable costs of modifications to a home in which a worker resides in Australia, where the modifications are reasonably required as a result of a work-related injury or illness and will impact on a worker’s access to and function within the home.

If a worker’s home cannot be reasonably modified for any reason, WorkSafe may contribute a reasonable amount to the purchase cost of a semi-detached portable unit or to the costs of relocating the worker to another home that is suitable for the worker or is capable of being reasonably modified.

Major Home modifications include: Any modification/contribution made by the agent for an amount greater than $10,000 where structural changes are necessary (eg moving internal walls or enlarging existing rooms) and/or extensive modifications in and around the house eg ramps, carports, bathroom and/or bedroom.

Minor Home modifications cost less than $10000 and include things like holding bars for the bath, different locks on doors; holding bar for toilet; rails etc.

Requests for home modifications can be initiated by any party, worker, family, medical and health practitioners, hospital but the actual home modification recommendations must be submitted by an Occupational Therapist (OT).

  • Household help

Household help refers to the provision of services for basic and routine common housework and gardening tasks that the worker performed pre-injury and are essential for maintaining the worker in the home.This also applies to injured workers who are living with a partner/spouse.

A referral is required from the worker’s treating medical practitioner. The treating medical practitioner must provide supporting evidence.

Note: WorkSafe will not pay for: the cost of cleaning materials;  food items; standard housework or household appliances; self care tasks including bathing, dressing or personal grooming; pet care; support of hobbies or personal lifestyle interests. For example: hobby farm, animal breeding or showing;  car care; home or furniture maintenance including window washing, cleaning or drapes blinds or carpets; home modifications including painting, renovation or modification; property maintenance or repair including painting, watering gardens, gutter cleaning or maintaining paving;  the cost of garden implements unless recommended by an OT as modification or assistive equipment for the  worker;  raw materials. For example: plants or mulch; fees for rubbish or grass removal.

  • Implantable pain therapy

Implantable Pain Therapy (IPT) is a procedure involving the use of an implantable device to address persistent pain and may be considered when a range of alternatives for managing persistent pain have been fully explored.

Implantable pain therapy incorporates:

·         intrathecal morphine infusion and other analgesic infusions (also known as intraspinal pumps)

·         neurostimulation techniques such as:

·         spinal cord stimulation

·         subcutaneous electrical stimulation

·         peripheral nerve stimulation

·         deep brain stimulation

·         motor cortex stimulation

·         other implanted neurostimulation devices for pain.

  • Medical practitioner services

The Act includes in the definition of a ‘medical service’, attendance, examination or treatment of any kind by a registered medical practitioner.

Note: WorkSafe does not consider it a reasonable cost to pay for the following:

·         letters of advice

·         the issue of repeat prescriptions when the patient is not in attendance

·         post mortem examinations

·         issuing of death certificate.

WorkSafe will not pay medical practitioners for telephone consultations, either to the worker or other related parties such as the agent, employer or occupational rehabilitation provider.Which I think is disgusting!

  • Independent medical examinations

Read more about workcover IME in our previous posts (just enter the word IME in the search box)

  • MRI

WorkSafe will pay the reasonable cost of an MRI service in accordance with the WorkSafe fee schedule for a worker where the service is:

·         required as a result of a work related illness or injury

·         referred by a registered consultant physician or specialist

Read more about MRI’s under workers compensation here

  • Loss and grief counselling

WorkSafe can pay the reasonable cost of loss and grief counseling services at the request of a medical practitioner if those services are required as a result of a work-related injury or illness.

Note: WorkSafe will only pay for the reasonable costs of family counselling services that are incurred in Australia, provided by a medical practitioner, registered psychologist or social worker approved by WorkSafe and provided to families of workers who have:  died as a result of an injury or suffered a severe injury.

  • Naturopathy

WorkSafe can pay the reasonable cost of naturopathy services at the request of a medical practitioner if those services are required as a result of a work-related injury or illness.

  • Nursing

WorkSafe can pay the reasonable cost of nursing services at the request of a medical practitioner if those services are required as a result of a work-related injury or illness.

Nursing services are services rendered by a registered nurse, other than at a hospital or as a member of the nursing staff of a hospital.

  • Occupational rehabilitation including training courses & ergonomic equipment

Occupational rehabilitation (OR) services are offered to a worker with a current work capacity (CWC) or a potential CWC to assist them to RTW.

Workers are entitled to receive an OR service from an approved OR provider of their choice from a list of at least 3 OR providers.

There are different types of Occupational rehabilitation services: RTW with same employer; RTW with new employer. See the online’s claims manual for more information (under “return to work”section).

  • Occupational physiotherapy

Occupational physiotherapists are physiotherapists with specific skills and experience in treating clients/workers and can help facilitate early rehabilitation and safe and sustainable return to work. Occupational physiotherapists collaborate with the client/worker, their employer, medical practitioner and other health providers. This includes conducting worksite visits, developing and implementing return to work programs and writing certificates of capacity.

  • Optometry

WorkSafe considers optometry to be a primary contact service.

A referral from a medical practitioner is therefore not required for the provision of optometry services.

A referral is required from a medical practitioner for provision of any approved health service with the exception of medical, physiotherapy, osteopathic, chiropractic, optometry, dental and podiatry services.

  • Osteopathy

WorkSafe considers osteopathy to be a primary contact service. Therefore a referral from a medical practitioner is not required.

  • Pain management programs

WorkSafe can pay the reasonable costs of Pain Management and Network PM Programs to assist workers in their rehabilitation of a work-related injury or illness.

Pain Management and Network PM Programs are multidisciplinary interventions which are designed to assist workers with musculoskeletal injuries and persistent pain to manage their condition and reduce the disability associated with their pain.

Pain Management and Network Pain Management Programs also aim to assist workers who are having difficulties: managing their injuries and participating in functional activities at home, work or in the community due to their pain or reducing their dependency on medications and allied health treatment due to their persistent pain.

A written referral from a medical practitioner can be sent directly to a Pain Management or Network PM Programs provider.  The agent will then consider the request for a PM or Network PM Programs assessment

  • Pharmacy

WorkSafe will not pay for medications and pharmacy items that:

·         do not relate to a work related injury or illness

·         are not provided on the request of a registered medical practitioner or registered dentist

·         are not provided by a registered pharmacist

·         are not provided at a reasonable cost

·         are prescribed as part of a clinical trial

·         were required prior to the worker-related injury or illness

·         are not invoiced according to WorkSafe minimum invoicing requirements

·         are not registered on the ARTG (except glucosamine).

Read more about medication entitlements under workcover in our previous post

  • Physiotherapy

WorkSafe considers physiotherapy to be a primary contact service. A referral from a medical practitioner is therefore not required for the physiotherapy services.

WorkSafe will also consider the reasonable cost of Gym and swimming program.

  • Podiatry

WorkSafe considers podiatry to be a primary contact service.

A referral from a medical practitioner is therefore not required for the provision of podiatry services.

  • Private hospitals

WorkSafe can pay the reasonable costs of private hospital services required as a result of a work related injury or illness.

Written approval is required from the agent prior to the provision of the service.

Note: Prior approval is not required for requests relating to emergency psychiatric inpatient treatment. If a hospital seeks prior approval, this must not be delayed.

A private hospital is a private hospital:

·         within the meaning of the Health Services Act 1988 or section 178 of the Health Act 1958

·         within the meaning of a law of another State or of a Territory

or

·         outside Australia if approved by WorkSafe.

A private hospital service means the provision by a private hospital of:

·         maintenance, attendance and treatment

·         nursing care and treatment

·         medicines, medical, surgical and other curative materials, appliances or apparatus

·         any other usual or necessary services provided by a hospital with respect to the treatment of the injury or illness of a worker.

  • Psychology

WorkSafe considers psychology to be a referral service. A referral from a medical practitioner must therefore be provided prior to commencement of psychology services.

  • Remedial massage

WorkSafe can pay the reasonable cost of remedial massage services at the request of a medical practitioner if those services are required as a result of a work-related injury or illness.

Remedial massage is defined as the application of manual massage techniques to treat musculoskeletal disorders or dysfunctions in a systematic way. Remedial massage is designed to improve the function of the injured worker in the rehabilitation process and achieve progress in return to work outcomes.

  • Removalist costs

WorkSafe can pay the reasonable cost of removalist services at the request of a medical practitioner if the worker is required to move as a direct result of a work-related injury or illness.

In order for WorkSafe to consider payment of the reasonable costs of removalist services the agent must be provided with the following information:

·  a current referral from a medical practitioner

·  at least two from quotes from removalist companies.

  • Respite care

Respite care services are services provided to assist workers with a work-related injury or illness who are being cared for at their place of residence (eg by family or household members) by giving workers and carers a short term break from their regular support routine. Respite care can be provided within a worker’s place of residence (e.g. by an attendant carer) or externally (e.g. accommodation facility such as an aged care facility, supported residential services, shared community housing, or a day program).

Respite care services are intended to assist the continuation of the primary informal support relationship between a carer and an injured worker whilst giving both the opportunity to rest and have a break.

To be eligible for consideration of respite care services, a worker as a result of their injury or illness must:

·  have substantial physical, psychological, cognitive or sensory disability which was sustained as a result of a work related injury or illness

·  require a significant level of ongoing daily/personal support (For example: hygiene, mobility, supervision etc)

·  have a family or household member who provides to the worker a significant level of ongoing daily/personal support

·  have been assessed by an occupational therapist and/or multi-disciplinary team, as requiring respite care.

A referral is required from a medical practitioner.

  • Social work

WorkSafe can pay the reasonable cost of social work services at the request of a medical practitioner if those services are required as a result of a work-related injury or illness.

WorkSafe considers social work to be referred service. A worker can access a referred service with a medical practitioner referral.

  • Speech pathology

WorkSafe can pay the reasonable cost of speech pathology services at the request of a medical practitioner if those services are required as a result of a work-related injury or illness.

WorkSafe considers speech pathology to be a referred service. A worker can access a referred service with a medical practitioner referral.

  • Travel expenses

WorkSafe can reimburse reasonable travel expenses incurred by a worker to attend medical and hospital services (this also includes physio, psychologist etc) required as a result of a work-related injury or illness in accordance with s99 of the Act. Travel and associated expenses incurred to attend an independent medical examination, impairment assessment or Medical Panel assessment can also be reimbursed as well as Conciliation (ACCS).

Requests for reimbursement must be submitted within six months of the date of travel.

Taxi travel is also possible, I will discuss this in a later post.



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3 Responses to “Medical and Like Services: Know your entitlements”

  1. Hi, thanks for spelling it out – I am going to get a gym and swimming pass (I didn’t know you could get this -> certainly not published in their stupid brochures!)
    Tony

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  2. Please see your union or solicitor to know all of your entitlements – that’s what these services are there for.

    The insurance company’s sole aim is to close your claim – this is despite them purporting to look after “your best interests”.

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  3. I like to spend my free time by reading diverse internet resources and today i came across your blog and I believe that it is one of the best free resources available! Well done! Keep on this quality!

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